If I could do it over, I'd see a physiatrist

Running Columnist

Tuesday, January 18th, 2005 10:00 PM

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By PAUL OPPENHEIM

The knee problems started in mid-2003 while training for the Chicago Marathon. My goal was to qualify for the 2004 Boston Marathon ?#34; the Holy Grail of running. And this time I was really going to run it. I'm not an avid marathoner, but back at the 1996 Chicago Marathon I was able to meet the Boston qualification time on my first try. Then I didn't bother to go. This time was going to be the real deal.

However, by late summer and with steadily increasing mileage my left knee was starting to feel stiff and uncomfortable. I'd done my first 20 miler in late August, but by the finish of the Park Forest 10-Mile race on Labor Day I was in big trouble ?#34; major swelling, stiffness and pain. The next week at a company physical exam, the doc, who also runs, didn't like what he saw and sent me for an MRI. It indicated a torn meniscus which he thought should be trimmed. I went to an orthopedic surgeon with lots of knee experience who gave the same opinion, but he suggested waiting awhile. After a three week layoff I tried another race, and the knee flared up again.

Surgery in late October trimmed a small tear in the medial meniscus cartilage. The arthroscopic surgery video also revealed some arthritis, and my surgeon pessimistically predicted serious future problems if I continued higher-mileage running. Post-surgery rehab seemed fine, but the return to running did not go so well, with knee and lower leg pain preventing my normal level of training.

Recalling the surgeon's gloomy prognosis, I decided to consult a sports medicine physiatrist (a rehab specialist), who's also an active runner. His assessment was much more positive. He prescribed a layoff, plus strengthening exercises and physical therapy, then a gradual phase-in of running. He also felt that arthritis was not a significant factor. His program was more successful, and though I ran a number of races in 2004, none were close to my previous times. But strangely, most of the soreness was on the opposite side of the leg from the surgery. What was going on? So my new doc ordered another MRI for a status report.

To our surprise, the scan revealed an old tear of the anterior cruciate ligament (ACL), which may have been way back in high school or even earlier (odd, but I didn't remember suffering such a major injury). The recent surgical trimming of the meniscus had also removed some of my knee's internal stability. And the loose ACL, which had never before posed a problem, was unable to provide stability, resulting in excess movement, pain and stiffness.

So my current treatment is a molded high-tech knee brace, to be worn for four about months. It's intended to re-program leg muscles and let surrounding tissues "scar-in" to increase knee stability. During this brace time I can power walk or bicycle. But no running until the brace comes off, dammit, and I've gained weight.

And the nagging question, of course, is whether I needed that meniscus surgery in the first place. After all, many of our ancestors probably had small meniscus tears from which they eventually recovered. Unless it's a major tear, or a cartilage fragment has locked in the joint, maybe the body can gradually smooth out the rough edges all by itself.

If I could do it again I would first go to the physiatrist whose initial course of action is non-invasive. I've talked to some runners who have had very successful arthroscopic surgeries and made full recoveries, and surgery is always an option if the conservative stuff doesn't work. But who knows if non-invasive treatment might have worked for me without the surgery and all this subsequent aggravation.